Oral health changes during pregnancy and their association with stress and salivary cortisol

Pregnancy is often seen as a joyful and eagerly anticipated time in a woman’s life, yet it is not without its challenges, as it brings about various physical and hormonal changes. Oral changes are one of those changes that are frequently encountered during pregnancy. This necessitates enough research on the prevalence of those oral changes in different populations, their possible reasons, their association with pregnancy-related stress and the possibility of salivary cortisol changes influencing the oral cavity. A total of 160 participants were included for the present observational cross-sectional study (40 participants in each trimester of pregnancy, 1st, 2nd and 3rd, and 40 non-pregnant participants as a control group). Data about demographic characteristics (including age and parity), oral health (including hard tissue and soft tissue changes) and quality of life during pregnancy (including vomiting history and perceived stress) were recorded. Unstimulated salivary samples were collected via spitting method, for measurement of salivary cortisol and salivary pH. Several oral findings, including gingivitis, soft‑tissue swellings, candidiasis, and dental erosion, were observed more frequently among pregnant participants compared with controls. Salivary cortisol levels were higher in pregnant groups, with the highest levels observed in the first trimester. Salivary cortisol level was found to be higher in the study groups than the control group, with the first trimester being the highest of all groups. Significant associations were identified between oral hygiene and caries incidence, vomiting history and certain oral mucosal changes, salivary cortisol levels and soft‑tissue lesions, and TPDS scores and soft‑tissue changes. These findings represent associations rather than causal relationships. Pregnancy was associated with a higher prevalence of specific oral and salivary findings, which showed correlations with psychosocial stress measures and salivary cortisol levels.